Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review

Abstract

BackgroundCatheter-associated urinary tract infections (CAUTI) are costly, common and often preventable by reducing unnecessary urinary catheter (UC) use.MethodsTo summarise interventions to reduce UC use and CAUTIs, we updated a prior systematic review (through October 2012), and a meta-analysis regarding interventions prompting UC removal by reminders or stop orders. A narrative review summarises other CAUTI prevention strategies including aseptic insertion, catheter maintenance, antimicrobial UCs, and bladder bundle implementation.Results30 studies were identified and summarised with interventions to prompt removal of UCs, with potential for inclusion in the meta-analyses. By meta-analysis (11 studies), the rate of CAUTI (episodes per 1000 catheter-days) was reduced by 53% (rate ratio 0.47; 95% CI 0.30 to 0.64, p<0.001) using a reminder or stop order, with five studies also including interventions to decrease initial UC placement. The pooled (nine studies) standardised mean difference (SMD) in catheterisation duration (days) was −1.06 overall (p=0.065) including a statistically significant decrease in stop-order studies (SMD −0.37; p<0.001) but not in reminder studies (SMD, −1.54; p=0.071). No significant harm from catheter removal strategies is supported. Limited research is available regarding the impact of UC insertion and maintenance technique. A recent randomised controlled trial indicates antimicrobial catheters provide no significant benefit in preventing symptomatic CAUTIs.ConclusionsUC reminders and stop orders appear to reduce CAUTI rates and should be used to improve patient safety. Several evidence-based guidelines have evaluated CAUTI preventive strategies as well as emerging evidence regarding intervention bundles. Implementation strategies are important because reducing UC use involves changing well-established habits.

Infecção do trato urinário associado ao cateter: Indicadores de Processo para análise das práticas de prevenção em pacientes críticos

“…Assim, sempre que possível, a inserção do CVD deve ser questionada quando as possibilidades de ser substituída por algum destes meios. 1,[8][9][10][13][14][15] Portanto, a conformidade encontrada no Indicador 1 para o setor da Emergência não a exime da necessidade de estabelecimento de ações de controle para ITU-RC, assim como para o setor do CTI que não obteve conformidade neste Indicador.…”

The effect of a short educational intervention on the use of urinary catheters: a prospective cohort study

“…The lack of qualified change champions within the wards to assist managers to implement changes also affected our choice of method. Using electronic alerts, which can assist in reducing CAUTIs [6,12,13] and allow easily accessible audits, was not an option because the hospital's electronic documentation system did not offer such features. Despite the decrease in the proportion of inpatient days with a catheter, the ratio was still quite high (41%) at T2 compared to some other studies [27], where it has been reported to be as low as 10% [28].…”

“…Diverse interventions that focus on limiting catheter use and on their prompt removal may significantly reduce CAUTIs [3, [9][10][11]. Education of nursing staff, electronic reminders aimed at reducing the duration of invasive devices [6,12], such as automatic stop orders [13], and the use of nurses specially trained to lead implementation projects (change champions) [12] have proved to be effective in changing practice and reducing CAUTIs [14].…”

Theraworx Skin Care Formulation Reduces Nosocomial Associated CAUTI Rates When Used for Urinary Catheter Insertion and Maintenance

“…Effective perineal protocols require nursing management, quality and supply chain acceptance and commitment for each institution. To date, only two methodologies have consistently proven to be effective in reducing CAUTI rates; implementing closed catheter systems and early removal of the catheter [7]. Scheduled cleansing of the catheter and urethral meatus, referred to as catheter care and maintenance, deserves scrutiny when designing a program to prevent CAUTI.…”

“…This demonstrates the soap and water care is beneficial as an initial step in a protocol to reduce macroscopic debris and prepare the perineum for application of other agents that may be additive in their effect on reducing CAUTI. Less than expected results from all products and methodology point to the need for quality improvement oversight and implementation for evidenced based practice guidelines including comprehensive education across all departments [11][12][13][14] …”